RESILIENCE AND MENTAL ILLNESS
"Resilience" is a resistance to the effects of stress, and is beneficial in relation to mental health problems. For example, studies have found that nurses working in intensive care units who had higher resilience coped better (Mealer et al 2012) (table), and likewise earthquake survivors were less likely to report subsequent Post-Traumatic Stress Disorder (PTSD) symptoms (Ahmad et al 2010) . While among 307 Norwegian 14-18 year-olds in Trondheim, there were significant negative correlations between resilience scores (using the Resilience Scale for Adolescents; READ ) and depression (-0.39), anxiety (-0.34), obsessive-compulsive (-0.29), and stress scores (-0.29) (Hjemdal et al 2011).
Engmann's (2013) pilot study in Germany found that higher resilience was beneficial in recovering from depression. The case notes of 503 in-patients at the Brandis Rehabilitation Centre between August and December 2011 were retrospectively analysed. Resilience was measured by a shortened German version of the Resilience Scale (RS-11) (Wagnild and Young 1993). This contained eleven items scored 1 (strongly disagree) to 7 (strongly agree) (eg: "I usually manage one way or another"; "I am determined"), where a lower score is low resilience (minimum = 11) and a higher score means higher resilience (maximum = 77).
Engmann (2013) made three predictions:
i) Individuals with higher resilience scores will have lower depression scores at the beginning of treatment. This was supported by a Pearson correlation coefficient of -0.63 (p<0.0001).
ii) Individuals with higher resilience scores with be more likely to have remission of depression symptoms within three weeks of treatment than individuals with lower scores. Sixty-one individuals were rated as having remission (defined as a score of ten or less on the Beck Depression Inventory; BDI), and 252 had no remission . The mean resilience score of the remission group was 53.56 compared to 41.77 for the no-remission group.
iii) Individuals with higher resilience scores will be more likely to be classified as "fit for work" after treatment than the lower scorers. The mean resilience score for individuals "fit for work" (n = 136) was 51.99 compared to 42.97 for those classed as "unfit for work" (n = 223).
Thirteen highly resilient nurses and 14 nurses with PTSD randomly selected from ICUs in the USA. Based on the interviews four domains emerged that distinguished the two groups:
1. Worldview - Resilient nurses "describe a worldview allowing acceptance that death is a part of life and that patient outcome cannot be controlled" compared to the other nurses with a worldview "aligned with regrets about patient outcomes and the inability to let go of negative experiences or the feeling that something more could have been done for a particular patient" (Mealer et al 2012 p1447).
2. Social network - eg: resilient nurses felt supported.
3. Cognitive flexibility - Resilient nurses showed this behaviour while the other nurses were cognitively inflexible.
4. Self-care and balance - eg: resilient nurses had a life outside work.
Table - Mealer et al (2012).
REFERENCES
Ahmad, S et al (2012) Earthquake impact in a remote South Asian population: Psychosocial factors and post-traumatic symptoms Journal of Traumatic Stress 23, 408-412
Engmann, B (2013) Could resilience predict the outcome of psychiatric rehabilitation patients? A pilot study Open Journal of Depression 2, 2, 7-10
Hjemdal, O et al (2011) The relationship between resilience and levels of anxiety, depression, and obsessive-compulsive symptoms in adolescents Clinical Psychology and Psychotherapy 18, 314-321
Mealer, M et al (2012) A qualitative study of resilience and post-traumatic stress disorder in US ICU nurses Intensive Care Medicine 38, 1445-1451
Wagnild, G.M & Young, H.M (1993) Development and psychometric evaluation of the Resilience Scale Journal of Nursing Measurement 1, 165-178